Building health and saving lives

A mother at the Malamulele Hospital prepares to breastfeed her baby, ensuring the baby receives all the nutrients that will give it the best start in life.

Hope shines at this hospital

9 June 2011 - It’s a sad fact that 83 per cent of Limpopo’s children live in poverty. So, you’d assume that this province’s Malamulele District Hospital probably performs poorly – especially since most of South Africa’s baby death rates are linked to district hospitals. But you would be mistaken. This hospital, despite its humble status, is a beacon of hope. It has seen a 30 per cent reduction in mortality since 2006, and its neonatal unit has reduced the number of infants who test positive for HIV at six weeks of age. It was around 13 per cent in 2007 – and by 2010, it had dropped to six per cent.

Life-saving care This life-saving difference was spear-headed by the Limpopo Initiative for Newborn Care (LINC), supported by the Limpopo Provincial Department of Health, UNICEF and Save the Children. Before the existence of LINC, newborn care was mostly seen as a routine task in post-natal wards. This meant that sick newborns often went unrecognised – with the tragic result that treatment was inadequate.

One of LINC’s priorities is to empower medical staff and management to improve newborn care services at community, district and regional levels. Combined with strong leadership and motivated staff, this initiative has led to mothers and babies receiving better care – and lives being saved.

LINC’s other priority is to train nurses who work in neonatal units, so they can offer excellent care to the most vulnerable babies – like those who are severely underweight. Malamulele Hospital is a success story – but challenges remain. Dr Stanley Langa, Senior Clinical Manager, says that the hospital’s ‘allocation’ ought to be 40 doctors, yet there are only 10. Four of these are doing their community service year. To cope with the shortfall, Dr Langa relies on private doctors, from surrounding areas, to help with shifts.

Angel Masiya’s grandmother, Nothisa Macebele recalls the joy she felt when she knew that her granddaughter would survive after being born premature.

Most fragile face toughest fight for lifeDr Benni Mathiba, a senior medical officer at just 32 years old, has the responsibility over the most helpless and vulnerable of beings – the perilously underweight and prematurely born infants in the neonatal unit of Malamulele District hospital. The tiny babies seem lost in their nappies as they struggle for life in the transparent incubators. Some of these newborns would fit in an adult’s hand. Below 2.5 kg is considered a low birth weight. To an observer, it seems unlikely that these little creatures can survive, much less thrive as fully functioning people.

Yet sitting on a comfortable couch in the visitors’ room is five-year-old Angel Masiya. She was born prematurely to her 16-year-old mother at just 29 weeks and weighed only 700 grams. Dr Anne Robertson, a paediatrician leading the Limpopo Initiative for Newborn Care says, “I would estimate her chances of survival in any rural hospital probably are less than 20 per cent and around 50 per cent in an urban central hospital.”

Angel should not have made it, but at Malamulele District Hospital, they have built a team that cares for babies like few other rural hospitals. One of the innovations the hospital introduced was the Kangaroo Mother & Father Care, where the importance of skin-to-skin contact for underweight infants was made a priority. The parent acts as a temperature regulator, increases parental vigilance and helps colonise the vulnerable child with the parent’s benign bacteria – boosting its immunity. The skin-to-skin contact is encouraged for fathers and grandmothers too – helping strengthen family bonds.

Whenever Dr Mathiba goes shopping at the local supermarket the parents of his former patients will go up to him to update him on the progress that ‘his’ children are making. Dr Mathiba did his community service at Malamulele District Hospital and was recruited just as the provincial neonatal programme was initiated. Even though he had no ambitions to be a paediatrician, he soon realised that he loved it.

“My cell phone is full of images of ‘my kids’. I follow up on the kids as they grow, and especially form a relationship with the grandmother of the child as she is the most stable person in the family.”